Unionized nursing homes tally fewer COVID-19 deaths, study finds

Media Credit: Courtesy of Adam Dean

Adam Dean, the study's lead researcher, said past research on the topic of COVID-19 in nursing homes focused on quality rankings.

Nursing homes with unionized staffs have logged fewer COVID-19 infections and deaths than nursing homes without them, a GW study from earlier this month shows.

Adam Dean, a professor of political science and the lead researcher on the project, found that unionized nursing homes in New York sustained a 30 percent lower COVID-19 mortality rate compared to nursing homes without unionized staff. Dean said unionized workers’ ability to demand access to personalized protective equipment, like N-95 masks and face shields, could explain the lower mortality rate among unionized homes.

Dean said earlier research on nursing homes during the pandemic focused on a potential link between the quality ratings of certain nursing homes and their respective COVID-19 mortality rates, but his research indicates that unionization is a more powerful explanatory variable for coronavirus death rates across nursing homes.

“In the broadest sense, the findings suggest that the benefits of unionization are not just limited to union members or the health care workers who are represented by labor unions, but potentially for residents in nursing homes or patients in hospitals perhaps and for the broader public,” Dean said.

Dean and his team used data made public by the New York State Department of Health to analyze COVID-19 mortality in 355 nursing homes from across the state.

Dean added that health care workers who are a part of the 1199SEIU, the main labor union representing health care workers in nursing homes in New York, have greater access to training funds through their union’s partnerships with nonprofit organizations and nursing homes. He speculated that these education programs could lead unionized workers to better understand how to properly use PPE.

He added that unionized workers are typically more likely to have access to paid sick leave, reducing their chances of infecting residents while on the job.

“It might be the case that unions may be associated with better outcomes for residents in the setting because unionized health care workers are more likely to have paid sick leave and therefore not come to work when they are sick,” Dean said.

Nursing homes in New York, which was an early epicenter of the pandemic, have been hit exceptionally hard as a result of COVID-19, with more than 6,500 deaths in nursing homes throughout the state. More than 77,000 nursing home patients have died of COVID-19, accounting for about 40 percent of total COVID-19 deaths in the United States.

Atheendar Venkataramani, an assistant professor of medical ethics and health policy from the University of Pennsylvania who worked on the study, said in addition to demanding adequate PPE, union workers have higher pay, potentially averting the need to work at more than one nursing home, which could lead to cross-contamination.

“New York City was actively discharging COVID-19 positive patients to nursing homes, and so it’s possible that unionized nursing homes managed the flow of infected persons into nursing homes differently than non-unionized nursing homes did,” he said.

Economic experts said the benefits of unionization include a wide network of support for worker access to PPE, which may contribute to lower COVID-19 mortality rates.

Brigham Frandsen, a professor of economics at Brigham Young University, said the study shows that adherence to PPE procedures could have led to lower death rates, which isn’t unique to unionized nursing homes and could be adopted at non-unionized nursing homes as well.

“The study suggests that it might be, and previous evidence suggests that it could be, adherence to procedural guidelines and better access to workplace safety equipment including PPE,” Frandsen said. “If that’s the case and I think the study gives evidence that it is, then certainly non-unionized workplaces could also implement those things.”

He said the study’s results shouldn’t be extrapolated across the board, but the findings provide valuable insight into how the U.S. health care system at large could implement procedural safety.

“One explanation for disparity is that unions traditionally in the collective bargaining process will advocate for adherence to procedural guidelines, maybe to a greater degree than would be present without a union,” he said. “And a situation like a pandemic or rising infection rates would be one where adherence to procedural guidelines could potentially reduce the risk of infection and fatality quite a bit.”

Aaron Sojourner, an associate professor of labor economics at the University of Minnesota, said the pandemic could prompt a greater push for unionization among nursing home workers.

“In every nursing home in the country, the new environment demands changes to the job and workers are being asked to shoulder the burden of that to a larger extent,” he said. “They want to have a voice in shaping those new rules of the workplace and the new design of their jobs in this new environment.”

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